SUPREME NUDGE background and overview of plans

The SUPREME NUDGE project is underway and its rationale and design was recently published in BMC Public Health. SUPREME NUDGE is a 5-year research project financed by the Dutch Heart
Foundation and ZonMw. With SUPREME NUDGE we expand a previous successful Dutch supermarket pricing intervention, and incorporate promising elements such as nudging and ICT applications to provide
real-time and context-specific physical activity feedback. More information can also be found on the dedicated website.

1st international symposium on lifecourse epidemiology and spatial sciences (ISLES)

During a week-long symposium organised by a small group of multi-disciplinary experts in both spatial science and public health gathered to explore a variety of open questions and pressing issues
in the field. Upstream Team was present to provide perspectives on some of the challenges that we face, including:

What, primarily, hinders the development of applications of spatial data and approaches for analysis in chronic disease research?

How could we link remote sensing to chronic disease epidemiology in theory?

How can we break the isolation of multiple disciplines caused by different principles and methods?

How can we measure life course and life-space environmental exposures of populations?

The symposium was well prepared and chaired by Peng Jia of
the University of Twente (Netherlands) and Peter James from the
Harvard Medical School. We look forward to the second edition, and in the meantime participants will use the input for scientific output!

June 2018

The Geoscience and Health Cohort Consortium (GECCO) 'pilot' project published

In the Netherlands, a great variety of objectively measured geo-data is available, but these GIS data are scattered and measured at varying spatial and temporal scales. The centralisation of
these data and the linkage to individual-level data from longitudinal cohort studies enable large-scale epidemiological research on the impact of the environment on health behaviours and health
outcomes. In the Geoscience and Health Cohort Consortium (GECCO), six large-scale and ongoing cohort studies from the Amsterdam Public Health research institute (APH) have been enriched with a variety of existing geo-data.
This pilot project is described in a cohort profile paper, led by dr. Erik Timmermans, has just been published in BMJ Open. This initial GECCO project already proved to be of value for many researchers interested in doing analyses on upstream
determinants, and its methods provide a great research potential which increases once more cohorts join. More soon!

Exploring the association between outdoor recreational facilities and leisure-time physical activity: the role of usage and residential self-selection

In this study first authored by Joreintje Mackenbach we analysed data from 5199 participants across Europe. Adults completed a survey and the availability of outdoor recreational facilities
in the residential neighbourhood was objectively measured. We found that

Subjective – but not objective – availability of outdoor recreational facilities was associated with higher levels of total leisure-time PA. After adjustment for self-selection (which attenuated
the association by 25%), we found a 25% difference in weekly minutes of total leisure-time PA between individuals with and without self-reported availability of outdoor recreational facilities.
For our study population, this translates to about 28 min per week. Participants who reported outdoor recreational facilities to be present but indicated not to use them (RR = 1.19, 95%
CI = 1.03;1.22), and those reporting outdoor recreational facilities to be present and to use them (RR = 1.33, 95% CI = 1.22, 1.45) had higher levels of total leisure-time PA than those who
reported outdoor recreational facilities not to be present. Read the details here.

Upstream research on display at the ISBNPA annual meeting in Hongkong

From June 3-6, the annual conference of the International Society for Behavioral Nutrition and Physical Activity (ISBNPA) took place in Hong Kong. The Upstream Team was well represented,
with various oral presentations and poster presentations. A symposium was also organised on challenges in upstream research. Suggestions for future studies that were given based on the content
and discussions afterwards included: use food purchasing outcomes rather than dietary intake (because then you know whether individuals actually interacted with specific shops); to engage with
land use planners and geographers to better understand why shops are where they are (in addition to understanding why individuals go to certain shops); to take into account affordability as an
important food environment exposure; to combine qualitative, quantitative observational and experimental studies to triangulate the findings; to balance specificity vs. complexity; etc.

Next year the conference will be organised in Prague - see you there!

February 2018

Built environmental characteristics and diabetes

The built environment influences behaviour, like physical activity, diet and sleep, which affects the risk of type 2 diabetes mellitus (T2DM). In order to assess and structure the current
evidence base on this topic, we systematically reviewed and meta-analysed evidence on the association between built environmental characteristics related to lifestyle behaviour and T2DM
risk/prevalence, worldwide. The results were just published in BMC Medicine in a paper led by Nicole den Braver. Overall, the
results indicate that living in an urban residence was associated with higher T2DM risk/prevalence (OR = 1.40; 95% CI, 1.2-1.6) compared to living in a rural residence. Higher neighbourhood
walkability was associated with lower T2DM risk/prevalence (OR = 0.79; 95% CI, 0.7-0.9) and more green space tended to be associated with lower T2DM risk/prevalence (OR = 0.90; 95% CI, 0.8-1.0).
No convincing evidence was found of an association between food environments with T2DM risk/prevalence.

A considerable proportion of European adults report little or no interest in physical activity. Identifying individual-level and environmental-level characteristics of these individuals can help
designing effective interventions and policies to promote physical activity. In our latest paper led by Eliana Carraça and published in Preventive Medicine we showed that adults who were not interested in physical activity reported a higher BMI and a lower self-rated
health and were less educated. They were also more prone to have less healthy eating habits, and to perceive more barriers towards physical activity. Only minor differences were observed in
environmental attributes: the non-interested were slightly more likely to live in neighborhoods objectively characterized as less aesthetic and containing more destinations, and perceived as less
functional, safe, and aesthetic.

January 2018

Contextual correlates of happiness

n our most recently published Upstream Team paper, just published in PLOS One, we aimed to examine the associations of both objectively assessed and perceived physical
and social neighborhood characteristics with happiness in European adults. Thousands of adults across Europe Respondents were surveyed and reported their level of happiness on a 5-point Likert
scale, and rated their perceptions of physical and social environmental neighbourhood characteristics. Objective physical environmental characteristics were also assessed, using a Google Street
View-based neighbourhood audit. Associations of 14 physical and social environmental characteristics with happiness were analysed.

Living in neighbourhoods that look better ('better aesthetics') and more water and green space was associated with being very happy. Individuals who perceived their neighbourhood to be safer,
more functional and more aesthetic were more likely to be very happy. The associations of functionality and aesthetics with happiness were strongest in the Ghent region (Belgium), the Randstad
(the Netherlands) and Greater London (United Kingdom). Individuals with a larger social network, more social cohesion and who trusted their neighbours were more likely to be very happy. The
association between social networks and happiness was somewhat stronger in men than in women. In general, the associations between environmental characteristics and happiness had similar
directions and sizes across socio-economic and socio-demographic subgroups.

January 2018

Upstream determinants of cooking at home

Cooking at home has been associated with healthier diets. While individual-level factors such as sex and employment status have been consistently associated with home-cooking, little is known
about its upstream determinants. In a study led by Maria Gabriela Pinho and recently published by the IJBNPA we explored the independent association between neighbourhood spatial access to grocery
stores and to restaurants with frequency of home cooking. We also tested how the interaction between these two type of stores are associated with home-cooking.

We found that greater access to restaurants was associated with lower frequency of home-cooking, while no association was found for access to grocery stores. We found no strong evidence for a
joint association of spatial access to grocery stores and spatial access to restaurants with home-cooking.

January 2018

Mediators and moderators of the food environment-obesity association

On January 1st, the journal Environment and Behavior published a study led by Upstream Team member Joreintje Mackenbach. In this study, we used data from the European Spotlight project to examine via which pathways, and for which subgroups, spatial access to fast food outlets was associated
with body weight in adults. We found that there was no direct relation between access to fast food outlets and body weight. However, access to fast food outlets was associated with perceptions
about and usage of fast food outlets, and this was in turn associated with greater reported fast food consumption and unhealthier weight status. We did not find evidence for effect modification
by age, gender, socioeconomic status or country.

January 2018

JPI – Policy Evaluation Network (PEN) got funded

The aim of PEN, which will start in May 2018, is to establish a multi-disciplinary research network for the monitoring, benchmarking and evaluation of policies that affect dietary and physical
activity as well as sedentary behavior with a standardized approach across Europe.

The Policy Evaluation Network will make use of the achievements of the DEDIPAC KH, especially Thematic Area 3 and combine it with other
existing tools and frameworks (e.g. INFORMAS) to develop a consistent and sustainable approach for the evaluation and benchmarking of existing
policies. The overal project coordinator is Wolfgang Ahrens, and the Vice-coordinators are Catherine Woods and Jeroen Lakerveld.